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Workforce Development and Continuing Education Application

Workforce Development and Continuing Education Application

Home » Workforce Development and Continuing Education Application

Home » Workforce Development and Continuing Education Application

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Application Information

Name(Required)

First Last

Date of Birth(Required)

MM slash DD slash YYYY

Social Security(Required)

Gender

Address(Required)

Street Address Address Line 2 City State ZIP Code

County of Residence(Required)

Cell Phone(Required)

Email(Required)

Driver's License #(Required)

State Driver's License Issued(Required)

State / Province / Region

Emergency Contact

First Last

Emergency Contact Phone

Do you receive SNAP Benefits?

Are you currently working?

Where do you work?

When did you start work?

MM slash DD slash YYYY

Demographic Questions

Please read carefully and answer the following questions:

Do you consider yourself Hispanic or Latino/a/x?(Required)

In addition to the above, select any or all of the following race classifications that you identify with:(Required)

African American/Black

American Indian

Alaskan Native

Asian

Caucasian/White

Hawaiian/Pacific Islander (Native)

Mixed Race

Other

Registration Information

Course/Program(Required)

Name of Course/Program

Start Date

End Date

Start Time

Campus/Location

Please press on the (+) on the right to add additional courses.

Certification, Citizenship, Refund Policy

Please read and initial the following statements:

Consent(Required)

I, the above-named applicant, do hereby attest that I am a citizen of the United States of America (by birth or naturalization) or a legal permanent resident of the US, or an alien lawfully present in the US in compliance with the SC Illegal Immigration Reform Act (SC Code An.59-10-430 (Westlaw 2008). I understand that DTC may require documentation to support my status.

Consent(Required)

I also understand that the department of workforce development and continuing education does not issue refunds unless a class is cancelled by the department itself. If I am unable to continue the class after the first session, I understand that I am not entitled to a refund, but may be offered a credit towards another course offering.

Consent(Required)

I recognize that tuition is due in full before the first class session. Failure to pay or make payment arrangements before the start of the course will result in removal from the course. Failure to complete any payment plan or arrangement by its deadline will result in ineligibility for the final exam, clinical, certificate of completion, and/or licensure exam and a grade of U – unsatisfactory.

Signature

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Statement of Nondiscrimination

Address

Physical Address:
1126 Solomon Blatt Blvd.
Denmark, South Carolina
29042-0327

Mailing Address:
P.O. Box 327
Denmark, South Carolina
29042-0327

Tel: (803) 793-5176
Fax: (803) 793-5942

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Denmark Technical College
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